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Thera 2 > Nutrition & Heme > Flashcards

Nutrition & Heme Flashcards

1
Q

What is the preferred prokinetic agent for AN and what is a side effect of it/what needs to be done?

A

Prokinetics = inc gastric motility
Domperidone preferred dt dec EPS symptoms
Risk of prolonged QTc esp with hypokalemia or hypoglycemia
Do ECG 1 wk before and after start of prokinetic. DC if Qtc inc by 50msec & switch to Prucalopride

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2
Q

What interventions should we give stable AN patients treating in the office and how often should you see them?

A

Weekly follow up appointments
Counselling on diagnosis, normalize eating, inc intake for wt gain
Thiamine IM x5 days with start of referring + PO zinc 100mg with meals x 2months
Can also attempt prokinetic agent at this point - domperidone (ECG)
Should follow up with non-urgent psych eval
If unstable, pt directly referred for urgent psych assessment

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3
Q

What popular antiemetic should not be used in eating disorder patients? What should be used instead?

A

Zofran is ineffective for this population
Metoclopramide instead as it has prokinetic and anti-nausea effects

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4
Q

Why is thiamine given to AN patients?

A

To prevent Wernicke-Korsakoff syndrome (encephalopathy induced by thiamine deficiency)

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5
Q

What prokinetic is preferred for constipation or for chronic laxative usage?

A

Prucalopride

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6
Q

What is refeeding syndrome?

A

A serious complication dt electrolyte disturbances - especially hypophosphatemia, which can occur when patients are fed after a prolonged period of minimal caloric intake or starvation

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7
Q

What is the first line treatment for bulimia?

A

Counselling and if after 2m ineffective, progress to pharm

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8
Q

What is the pharmacological treatment for bulimia?

A

SSRI - Fluoxetine (Prozac) - most evidence for BN
also SNRI - Venlafaxine (Effexor), SARI - Trazodone

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9
Q

Can Wellbutrin be used for ED its with depression?

A

No, it is contraindicated due to seizure risk

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10
Q

What BMI is classified as obese?

A

> 30 BMI

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11
Q

What can be used to stage obesity and show mortality risk?

A

Edmonton Obesity Staging System
0 (no risk factors) - 4 (sever disabilities/limitations)

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12
Q

What are the first line treatments recommended for obesity?

A

Behaviorally based interventions focused on diet, exercise or lifestyle changes alone or in combination.

Life-style changes include counselling, education or support, and/or environmental changes in addition to changes in exercise and/or diet.

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13
Q

What are the obese waist circumferences in males and females?

A

Males 102cm (40in)
Females 88cm (35in)

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14
Q

What is the treatment strategy in phase 1 of weight loss?

A

Caloric deficit of 500kcal/day = 1-2kg loss/month
Ensure high quality protein intake & participate in resistance training
After 3-6m advance to phase 2

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15
Q

What is the treatment strategy in phase 2 of wt loss?

A

Continue restricting energy intake indefinitely to the same level as was consumed at the time of the weight-loss plateau. Any increase in energy intake will result in weight regain. Deep-rooted lifestyle changes, intense physical activity, medication and surgery can significantly reduce the likelihood of weight regain.

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16
Q

What are the non-harm weight loss strategies?

A
  • caloric restriction
  • diet counselling
  • 3 meals & 3 snacks/day
  • Avoid fasting or skipping meals
  • Avoid night time eating close to bedtime
  • Ensure an adequate carbohydrate intake of ≥100 g/day
  • Ensure a protein intake of ≥1 g/kg/day of high-quality mixed proteins
  • Fat intake should not exceed 30–35% of total calories consumed, with ≤10% from trans and saturated fat
  • Increased physical activity, 30mins of activity 5x/wk
  • Exercise coupled with a judicious caloric-deficit meal plan accelerates fat loss while maintaining lean body mass, and helps sustain weight loss over the long term
  • Walking 10 000 steps/day
  • Treadmill stress test recommended if cardio risk present prior to activity
  • Bariatric surgery can be considered for severe obesity
17
Q

What are some appetite suppressant drugs we can give for obesity? What does the BMI have to be to start these?

A

Bupropion (mild suppressant) plates at 24wks - not recommended Bupropion/Naltrexone preferred: naltrexone combo allows for further wt loss to occur over 48wks
CI in MAOIs & opioids

Liraglutide (Saxenda) SC injection (GLP-1 Agonist): used for T2DM and wt management to suppress appetite, slow gastric emptying = wt reduction of 8kg through 2 years. Start at 0.6mg weekly and titrate up by 0.6mg increments until 3mg is reached
++GI effects

BMI >/= 30 or >/=27 + 1 wt-related comorbidity

18
Q

What is orlistat used for?

A

It is a lipase inhibitor that reduces dietary fat absorption
++GI effects with high fat intake
Recommended to take a multivitamin with it taken 2hr prior to orlistat

Poor side effects oily, gas discharge and fecal urgency

19
Q

What are the fat soluble vitamins?

A

A, D, E & K

20
Q

What are the water-soluble vitamins?

A

Thiamine (B,) riboflavin (B2), niacin (B3), pantothenic acid (B5), biotin (B7), folic acid (B 9), CYANOCOBALAMIN (B12) & ascorbic acid (C).

21
Q

What supplements are recommended in pregnancy & Breastfeeding?

A

Folic Acid amt ranges dependent on neural-tube risk from 0.4mg-4mg/day
0.4 - mild risk
1mg (until 12wks) then 0.4-1mg until 4-6wks PP or BF stopped - mod risk Diabetes, fam hx, malabsorption
4mg High Risk - personal hx (yourself born with defect) or personal pregnancy with defect until 12wks
Calcium 1000mg/day for >19yrs of age
Vit D 600-2000u/day (higher range for pregnancy during Winter)
Iron (only if deficient) 27mg/day

22
Q

What supplements would be recommended for vegans?

A

Vit B12, D, Ca, Iron, zinc, Omega-3 fatty acids

23
Q

What supplements would be recommended for alcohol abuse pts?

A

Vit B1, B2, B6, C, folic acid

24
Q

What supplements would be recommended for the elderly?

A

Vit B12 (if deficient) and D

25
Q

What supplements would be recommended for those at risk for malabsorption ie bariatric surgery?

A

Fat soluble vitamins (A, D, E, K), B1, B12, C, folic acid, Ca, Copper, iron, selenium & zinc
Must take for 2 years or more post op

26
Q

What is the recommended amount of Vit D Canadians should be supplementing with?

A

For adults 19-50yrs: 400-1000u daily
>50 yrs: 800-2000u daily
Obese, low-sunlight or non-European: 2000u/day

27
Q

What are the calcium recommendations?

A

Total overall calcium intake should be limited to <1200mg/day (food + supplements)
Calcium carbonate should be taken with food
Calcium citrate can be taken on its own
Elemental calcium dose should be <500mg

28
Q

When should peads patients start cows milk?

A

9-12m

29
Q

How long should someone be on iron supplementation?

A

Should be continued for 3m post anemia correction

30
Q

What is the first line iron treatment?

A

Ferrous Sulfate (cheapest)

31
Q

Which Iron is best for dialysis patients?

A

IV iron: Ferric Gluconate

32
Q

Whats a normal Tsat?

A

> 20%

33
Q

T/F: There is a high risk of anaphylaxis with IV Iron transfusions?

A

True

34
Q

Which individuals are at risk for macrocytic anemia?

A

B12 deficient: Vegans, Alcoholism, Crohn’s disease, gastrectomy, age > 60, Caucasian/Northern European, immunologic diseases.
Folic Acid deficient: Diet deficiency (fresh fruit/vegetables), polypharmacy, Alcoholism, Crohn’s disease, Gastrectomy (absorption disease), over age 60, frequently seen with immunologic diseases, Hemodialysis.

35
Q

Describe the Maudsley method

A

1) Psychoeducation
2) Family Intervention
2) Family Systems Therapy - trains the family to make decisions regarding goals of child

36
Q

When can psychotherapy start

A

Once they have approached/regained a normal body wt?

37
Q

Edmonton Obesity staging system

A

1-4 (3 - end organ damage, 4 - severe life limiting)

Thera 2 (9 decks)

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